| Summit Oral Surgery Llc | |
|
1700 E Bogard Rd Ste B202 Wasilla AK 99654-6570 | |
| (907) 357-3414 | |
| (907) 357-3714 |
| Full Name | Summit Oral Surgery Llc |
|---|---|
| Speciality | Dentist |
| Location | 1700 E Bogard Rd Ste B202, Wasilla, Alaska |
| Authorized Official Name and Position | Matthew Anthony Welch (MEMBER) |
| Authorized Official Contact | 9073573414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Oral Surgery Llc 1700 E Bogard Rd Ste B202 Wasilla AK 99654-6570 Ph: (907) 357-3414 | Summit Oral Surgery Llc 1700 E Bogard Rd Ste B202 Wasilla AK 99654-6570 Ph: (907) 357-3414 |
| NPI Number | 1174709927 |
|---|---|
| Provider Enumeration Date | 01/10/2008 |
| Last Update Date | 01/10/2008 |
| Medicare PECOS PAC ID | 1052490828 |
|---|---|
| Medicare Enrollment ID | O20080505000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174709927 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1159 (Alaska) | Primary |
| Provider Name | Leonardo M Rios-andersen |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1699735050 PECOS PAC ID: 3577746247 Enrollment ID: I20110318000229 |
| Provider Name | James A Wimsatt |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1083601686 PECOS PAC ID: 3870727514 Enrollment ID: I20131011000090 |
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